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Lymphoma of the lumbar nerve root: case report
R Viswanathan1, N K Swamy, J Vago
1Department of Neurosurgery, Christ Hospital, University of Cincinnati College of Medicine, Ohio, USA.
Background And Importance:
Lymphoma deposits in the spine are typically extradural. However, we report the case of a 38-year-old man who had a peripheral T-cell lymphoma with both intra- and extradural involvement.
Clinical Presentation:
The patient presented with a 3-month history of right hip and thigh pain. Computed tomography and magnetic resonance imaging revealed features indistinguishable from those of a benign neurofibroma, except for a small area of T2-weighted signal abnormality in the third lumbar vertebral body.
Intervention:
A solitary lesion of the right third lumbar root with normal surrounding bone and soft tissue was excised at surgery. At immunohistopathological evaluation, a diagnosis was made of peripheral lymphoma. Postoperative evaluation did not reveal lymphoma in the cerebrospinal fluid, abdomen, chest, blood, or bone marrow. This case illustrates that lymphomas can grow in patterns indistinguishable from a tumor of a nerve root. Therefore, other treatment modalities would have been considered had the diagnosis of lymphoma been made preoperatively.
Conclusion:
Involvement of a solitary nerve root by lymphoma, although rare, should be suspected in all cases of nerve root neurofibroma, and magnetic resonance imaging should be performed. Even minor signal abnormalities in adjoining vertebrae signal the possibility of malignancy. Percutaneous biopsy of suspicious bony lesions and systemic evaluation can demonstrate other sites of involvement, enabling the confirmation of the diagnosis and appropriate treatment without recourse to surgery.